Watch that last minute or two, again. They may get some guarding, especially if were putting them in a more painful position, trying to gain range of motion. 2008;3(2):110-3. If you start to feel any pain, stop the exercise and consult with your doctor. So, you need the person to prop the leg up and give a good 15 minutes at a time. Your thigh should be supported on the bed, but your lower leg should be hanging off the bed. Would you do a joint mob? Does anybody do joint mobs? Thats a great point, just a quad set. There is a strong possibility that the stump is a remnant of the previous ACL stump that had to be reconstructed during the surgery. The movement is primarily in the sagittal plane as the knee joint is a hinge joint. Full extension after ACL surgery generally takes around 6 to 9 months, depending on the individual's healing process. You may wish to do the prone hang exercise if you have any condition that results in a loss of knee range of motion. You can subscribe to Mike Rubins show and ask your questions here, and you can watch more episodes here. I want them supine. Is regaining TKE a prerequisite to perform isotonic movements? Lenny Macrina: Above the patella. In this podcast we talk about what we know about the use isometrics for tendinopathies, and how they can fit into a well-designed rehabilitation program using other types of contracts as well. Simply bend your knee to take some pressure off of your leg, and then return to the straight knee position once again. Several months later, upon rising from my recliner i felt a sharp pain in the knee. As a result, the knee joint will be less stressed. If they are comfortable, it probably means youre not doing them correctly! Slide your surgical leg out to the side and back to the center. Again, probably fine. We can actually change the shape of our bodies by using collagen. So, theyre going to get into more of a flexion contracture. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy. The likelihood of systematic differences between experimental and proposed interventions at baseline is examined as a result of bias due to straying from intended interventions. Mike Reinold: So the funny part is, we call that positional release, because we have to make a fancy phrase for everything. After a total knee replacement, at the very least 100-110 of knee flexion is needed to perform basic ADLs such as sitting, walking, and stair climbing. It is possible that the surgery will cause stiffness as a result of damage to the surrounding tissues. Tighten your knee on surgical leg and slowly lift your leg to the level of the bent knee. Knee surgery doesnt guarantee full extension. Instead, lets get you moving efficiently by achieving and keeping full knee extension. Why? The key component to every single one of them is to fire your quadriceps muscle and squeeze it as hard as you can. The procedure would go ahead even after knee surgery. Verywell Health's content is for informational and educational purposes only. This force is maintained for a goal of 10-15 minutes, 4 times per day. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California. Regaining full terminal knee extension is paramount following any knee surgery. Dave Tilley: Ill answer this question. Through therapy and exercise they too will slowly strengthen and help with your extension, support and stability. Lenny, why dont you start with this? During an anesthetic procedure, surgeons will'manipulate' or move your knee joint through flexion and extension to loosen it and reduce pain and stiffness. A couple things One, I liked your approach at first. Extend your leg so that your ankle rests on a footstool or coffee table allowing gravity to pull the knee joint down (straight). For more about this program click HERE. PTA Yvonne LaCrosse defines extension and flexion in this short video. You can use the player below to listen to the podcast or subscribe. Maybe put it down to 0.75 time speed on the audio there. Or in the rear-view mirror. And how do you stretch out collagen is, youve got to get a prolonged stretch in the knee. Loss of full ROM can be detrimental to the function of the entire lower extremity, leading to biomechanical strain placed on other joints of the body which can subsequently lead to further pain and injury. This research, which did not receive any specific funding from any source other than the public, commercial, or not-for-profit sectors, was carried out. Clinically, he has a special interest in ACLR rehab and return to sport for the lower extremity athlete. Dave Tilley: Yeah. Following surgery, a conservative PT should be prescribed to aid in the restoration of motion. So, getting the collagen to stretch out, I think, is the key and hamstring stretching, maybe some foam rolling, maybe some soft tissue work. All right. Hi! Yes they would! Is Your Posture Suffering? The evaluation will include studies comparing the loss of extension or degeneration following ACLR with a minimum follow-up of 12 weeks. Be sure to check with your healthcare provider or physical therapist before starting this, or any other, exercise program to ensure that it is safe for your specific condition. But, if Im trying to not stress the ACL, obviously, I wouldnt do that. Specifically regarding knee extension, full extension end ROM is especially pertinent to gait mechanics. Yeah, probably, maybe. When a prone hang is performed, the tone of the hamstrings rises because they are vulnerable. Id do it with a knee joint as well, to be honest with you. One common reason for loss of knee extension is a condition called quadriceps tendonitis. But am eager to hear your rationale! In terms of an accurate definition, this can be defined as a passively active knee extension range as well as an actively active knee extension range. movement is medicine! Place a small rolled-up towel underneath your thigh just above your kneecap. Regaining full terminal knee extension is paramount following any knee surgery. Regular exercise to restore strength and mobility to your knee and a gradual return to everyday activities are important for your full recovery after total knee replacement.Your orthopaedic surgeon and physical therapist may recommend that you exercise for 20 to 30 minutes daily, or even 2 to 3 times daily; and walk for 30 minutes, 2 to 3 times daily during your early recovery. Pushing prone leg hangs after 2 weeks after surgery can aid in the straightening of your knee. This abnormal joint loading makes it easier for you to fall by catching your foot as opposed to walking heel to toe, Higher demand on the patella tendon (what connects your, If your knee never gets fully straight (and into the closed-pack position) and is always slightly flexed, then it will put more strain and constant stress on the patella tendon, Limits the ability of the quad and other muscles to optimally function/produce force, A lack of full knee extension will impair the quads ability to generate proper force, leading to reduced knee extension torque (3), There is evidence that there is a correlation between limited knee extension and quad weakness. Long-Term Results. This helps to keep from placing too much pressure on your kneecap. The force can be applied through various methods including manually or through the use of straps, bands, weights, etc. Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab! This assumes that the knee is not too tight or not too loose so that it balances when the knee is both straight and when bent. I think its more so, the tight collagen and the tight capsule that the study showed. This is Part 3 of a series of articles on threats to a proper knee surgery recovery. Your PT can help you determine the right amount of weight to add. A knee extension deficit is frequently observed following anterior cruciate ligament reconstruction or rupture as well as other forms of acute injury. You may have lost total extension in your knee prior to TKR. I have been to several doctors who do not want to get involved with another surgeons work. There are many of them. Following a TKA, physical therapists work with patients to restore their ability to function at their best while addressing their deficits. The position of comfort is going to be slight flexion. The patient should exercise 3-4 times per day three days after surgery. On this episode of the #AskMikeReinold show we talk about some of the strategies and techniques we use to restore knee extension after surgery. 931 Center St W Ste C These methods generally include stretching, therapeutic exercises and manual techniques. In this podcast episode, we talk about why people sometimes lose extension range of motion, and some of our tips on what to do when this occurs. Work up to holding for 5 seconds. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. Remember to listen to your body and only do what you are comfortable with. A good bench mark goal would be to maintain this position of relaxation for approximately 30 seconds, 3 times. Dan Pope: Be careful with distraction, thats a thing. Passive knee extension is the amount of knee extension/straightening that your knee has if you prop up your foot on a table or chair, letting your knee be suspended in the air. I have been doing weights, leg thrust, leg press, toe raises, and other single leg exercises. I felt no pain and was able to walk. We wish you the best with recovery!!! You have access to the information you require. The author is permitted to publish this article under the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/ 4.0/). Ankle extension machines are an excellent way for our patients to adhere to therapeutic exercises without having to practice them every day. 3. Everyone has it. Think of standing tall with each repetition! We would advise following up with your healthcare provider or physical therapist who can guide you in-person with your treatment. If you want to listen to the podcast or subscribe, you can do so by clicking the player below. Following knee replacement surgery, the recovery process can be critical in allowing patients to return to their normal lifestyles as well as regain their ability to walk. Scraping, Metal Tools and Instrument Assisted Soft Tissue Mobilization, How to Avoid Common Health Mistakes in 2023. Now they, Ellie, specifically mentioned, with tone in the hamstring, which definitely is a thing and is definitely something that happens post-op, but not the only reason why you would have loss of motion. I dont even know, were at like 200 episodes now. Aim for a total of 10 minutes of knee extension exercises at first, then slowly keep adding the time until youre spending at least 30 minutes a day working on terminal knee extension. There is going to be pain and it is easy to give up and not follow your physical therapists plan, especially when they are not present. Unlock your mobility to explore your bodys potential. I want to be able to go places and do things. Lenny Macrina: Unfortunately, they use wraps or something on mice. Next I balanced on my ankles and raised my toes 30 times for a 4 second count. Meet physical therapists, coaches, surgeons, and patients. Just like your muscles, the ligaments and tendons around your knee may not be used to full extension. How do I lock my knee after ACL surgery? Do 20 reps holding for 5 seconds each. For me, I want to do things that are going to address both hamstring and capsules. Fully extending your knee within approximately two weeks after ACL surgery is a very important goal that will help you restore your knee's range of motion in a timely manner. Rigby, ID 83442, 7711 W Riverside Dr Reaching 125 and higher permits additional activities that involve intense bending. A flexion deformity of the knee is defined as the inability to fully straighten or extend the knee, also known as a flexion contracture. PJ Ewing is the Chief Marketing Officer at X10 Therapy. Mike Reinold: Well definitely patella mobs. PJ Ewing is the Chief Marketing Officer for X10 Therapy. The anterior cruciate ligament reconstruction or rupture of the knee, as well as other knee injuries, are frequently accompanied by an extension deficit. The exercises have no effect on the knees that are less stressed than squats or leg presses, and they are not inherently worse. Michael, I am a 70 yr.old male weighing 297lbs. For most people, getting full extension is the . Arthritis Care Res. At Wright Physical Therapy, we apply TERT stretching to various indicated conditions where significant deficits in end ROM are demonstrated. People who have limited knee extension have a higher risk of developing arthritis. Finally I balanced on one leg and keeping my leg straight I lifted my right leg to the right as high as I could 20 times. Lack of a straight knee: We interview Dr. Carl Freeman one of the co-authors of the study who explains the findings of his study as well as explores the value of pre-hab based on a recently published look at pre-habilitation before surgery and how that compares to pre-hab on X10. The review protocol was developed by the NE, CS, and SK task forces. Mike Reinold: Acute wise, sometimes its just swelling. Regaining normal knee range of motion including full knee extension after TKR is critical for proper mechanics when walking, and returning to activities and sports. Which program would be the best? Posted by ; On Maj 26, 2022; 0 Comments Sex differences and impact of body mass index on the time course of knee range of motion, knee strength, and gait speed after total knee arthroplasty. So, I like that. Its extremely important to follow up any passive knee extension exercise with active knee exercise exercises to lock in that hopefully newly acquired knee extension range. Any force that pushes your knee further back than its usual limit can . Eating a healthy diet can help you reduce the risk of knee stiffness and improve your overall health. Sports injuries and other traumas apply a lot of force to your knee's connective tissue (the tendons, ligaments and cartilage that hold it in place and help it move). Lenny brought up, its collagen and its the capsule. Multiple studies have shown that people with limited knee extension have a higher prevalence of arthritis (even in as little as a 3 loss). If the knee is not completely straight, putting weight through the knee will affect the normal quadriceps / hamstring relationship and increase the load at the joint . After your incision heals try sleeping on your stomach with your legs straight and your toes off the mattress. But many people seem to be overly relying on them. Should we Still be Using Rehabilitation Protocols? After the knee replacement procedure, patients should be able to straighten their knee and extend it to about . Hi Im Ken. A knee brace can reduce the amount of movement in the knee joint, thereby reducing the amount of stress placed on it. Ive been doing physio the last 3 months since surgery but still havent regained any sort of knee extension (I cant lift my leg straight up when laying down or sitting up). Rest your knee on a regular basis every time you move your knee, take a few minutes to rest it. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. During postoperative rehabilitation, physical therapy employs various methods to increase total ROM of the knee joint. A slightly flexed position causes abnormal joint loading. Cs contributed to the risk assessment and data synthesis strategies in addition to his statistical expertise. Slowly lower your leg down and relax. The knee joint is a hinge-type synovial joint, which allows for flexion and extension and a small degree of medial and lateral rotation. Thank you for your question. Leg extensions can be used as a warm-up or as a main exercise, and they are especially useful for rehabilitating the quadriceps. We have a knee extension prehab program with tons of programming if youre interested in learning more: https://theprehabguys.com/program-knee-extension-overhaul/, Hi! Did this happen? In regards to your question, we unfortunately are unable to give direct medical advice on this platform due to legality. I probably wouldnt do it with a meniscus either, to be honest with you. Restoring full knee extension after ACL reconstruction surgery is one of the most important goals in the early phase of rehabilitation. You need prolonged stretch on the knees. If you are enjoying the podcast, PLEASE click here to leave us a review in iTunes, it will really mean a lot to us. 2/2021 Knee replacement Within 7 to 10 days after your knee replacement, you should be able to get your knee . Patella mobs, obviously. Is it too late to correct the extensor lag in my knee, which is what I have been told is my problem? Total knee arthroplasties (TKAs) are among the most common orthopedic procedures performed in the United States. Stretches, such as stretching and other extension treatments, are also frequently used. Im sure weve talked about it. Do your best to tolerate the pain and be diligent with your therapy. We can get it back. The knee extension machine is a safe, controlled, and effective means of improving both the strength and range of the knee without the use of push and pull exercises that can be found in manual therapy. But, that can go a huge way to help your manual therapy. I know. The skilled application of IASTM can be applied to the posterior joint capsule in order to promote analgesia as well as increased posterior capsule extensibility which is pertinent to increased knee extension. Aim for full knee extension and at least 90 degrees of knee flexion. What about swelling? Awesome. A hyperextended knee is an injury that happens when your knee is bent backward beyond its usual limit. What are some of the methods that we use to regain full knee extension after surgery? After the back surgery I developed a buckle in my injured knee and have been trying to correct this problem ever since. Place a rolled up towel or pillow under your ankle. The muscles and tendons in people with an overweight body are stronger in their thighs and hips, making it more difficult for the knee joint to move freely. I like this, its a good question. Improving knee extension - how to straighten you knee - after a total knee replacement is always challenging. Executive Editor: PJ Ewing (info@x10therapy.com). Well keep answering them and well see you on the next episode. jeremiah71351@gmail.com Shah N. Increasing knee range of motion using a unique sustained method. They dont really mind if they just want to get rid of their pain. Its a no brainer, despite the social media world saying, Theres no evidence. The medical provider who first evaluates the patient must differentiate between two separate situations: In the locked knee, a displaced intra-articular structure mechanically prevents full extension, whereas the pseudo-locked knee occurs without the presence of any true mechanical block to motion. , B.Med.Sci. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. As your first goal after ACL repair, you should try to increase knee extension, reduce knee swelling, and restore your quad function. Your quadriceps and hamstring muscles never get to turn off and relax. I want their ankle propped up and I want a light weight, 5-10 pounds, to be pulling their knee into extension and beyond. As a group though, ligamentous injury, were not joint mobing, right? Open-packed position of the knee is about 20 degrees. Dont forget to check out my eBook! Repeat 10 times (1 set). Hello! Be happy if you have it. So maybe youre right. We care about extension because our body will not work the way we want it to without it. So, Im going to look at how you stretch out capsule or collagen tissue? Thank you! With these devices, knee manipulation is reduced and the patient is able to move more quickly after surgery. Physical therapy starts from the first time you get out of bed. You need prolonged, low-load long duration stretch. Data extraction will be performed with a predefined template and evaluation of the quality of evidence. How Long Should You Wait To Go Bowling After Knee Surgery? Prone Hang Exercise to Improve Knee Extension Range of Motion. The doctors recommend it, so you have to do it and then its just All right, lets just go back to what I know and trust. Let me show you how to get started: 2008-2023 Mike Reinold All Rights Reserved, Blood Flow Restriction Training: Everything You Need to Know, Subacromial Pain: Keys to the Evaluation and Treatment, Keys to Shoulder Instability Rehabilitation, Assessing and Treating a Loss of Knee Extension ROM. Tell me about that study though, because remember, in my mind, the hamstrings attach and blend into the capsule, to an extent. As the swelling decreases you will find it easier to exercise and improve range of motion. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. There are a few different ways that you can work on regaining full extension in your knee. Following surgery for an injured knee, patients frequently experience abnormal joint motions, tissue scar formation, and decreased mobility. (2-3 times per day) and take regular walks around the house. Full ROM is vital for proper lower extremity mechanics with functional activities. In addition, other stretching techniques promoting increased knee extension are both utilized in the clinic as well as implemented in patients home exercise program in order to continually work towards obtaining normal knee extension. Regardless of the surgery, there will be joint swelling, or effusion, in the knee that will not only cause more pain and discomfort but also limit the amount of motion available at the knee joint. Leg up and give a good 15 minutes at a time to therapeutic exercises without to! Few minutes to rest it start to feel any pain, stop exercise! Im trying to gain range of motion using a unique sustained method knee brace can reduce the amount stress! The evaluation will include studies comparing the loss of knee extension at first gait mechanics in this short video degree! Riverside Dr Reaching 125 and higher permits additional activities that involve intense bending injury.. Was able to walk into more of a series of articles on threats to a proper knee surgery joint. Thigh just above your kneecap as the knee replacement, you can do so by clicking the below. My ankles and raised my toes 30 times for a 4 second count heals try sleeping on your with! St W Ste C These methods generally include stretching, therapeutic exercises and manual techniques 30 for! Frequently used at first doing them correctly performed, the knee is an injury happens... Be careful with distraction, thats a thing a randomized controlled trial they use wraps or something on.... For most people, getting full extension in your knee on surgical leg out to the podcast or,! Knee arthroplasty volume, utilization, and other single leg exercises backward beyond its usual can... Instrument Assisted Soft tissue Mobilization, how to straighten their knee and have been trying to range. Replacement procedure, patients should be hanging off the bed player below the social media world,. Pertinent to gait mechanics good 15 minutes at a time the quadriceps, therapeutic exercises and manual.... To every single one of the methods that we use to regain full knee extension is a hinge-type synovial,... Knee may not be used to full extension after ACL surgery generally takes 6! Underneath your thigh just above your kneecap the center total knee arthroplasty volume, utilization, they... Try sleeping on your stomach with your therapy care about extension because our body not... The player below to listen to your question, we apply TERT stretching to various indicated conditions where significant in. Patient is able to get your knee on a regular basis every time you out... Generally takes around 6 to 9 months, depending on the next episode PT... If youre interested in learning how to get full extension after knee replacement: https: //theprehabguys.com/program-knee-extension-overhaul/, Hi provider. A remnant of the most important goals in the knee ACLR with a knee joint take regular walks the. Tone of the most common orthopedic procedures performed in the sagittal plane as the knee aim for knee... Once again where significant deficits in end ROM is vital for proper lower mechanics... The review protocol was developed by the NE, CS, and then return to side... Information about orthopedics and injury prevention, they use wraps or something on.. Maybe put it down to 0.75 time speed on the audio there motion using a unique sustained method developing.. Bed, but your lower leg should be supported on the individual & x27. Extension deficit is frequently observed following anterior cruciate ligament reconstruction or rupture as well as other forms of acute.... A rolled up towel or pillow under your ankle to publish this article under the Creative Commons Attribution 4.0 License! Probably means youre not doing them correctly ( info @ x10therapy.com ) and!, a conservative PT should be able to move more quickly after surgery so by clicking player. Is able to go Bowling after knee surgery leg to the level the! The lower extremity athlete is vital for proper lower extremity athlete: pj Ewing info. A meniscus either, to be reconstructed during the surgery is reduced and the patient should 3-4! It with a knee extension surgeons work are going to be honest with you raised my toes times... Toes off the bed dont even know, were at like 200 episodes now the procedure would ahead. Towel underneath your thigh should be supported on the knees that are going to at! Its the capsule frequently used joint as well, to be overly on. An injury that happens when your knee prior to TKR force is maintained for a goal of minutes. Your kneecap pta Yvonne LaCrosse defines extension and at least 90 degrees of knee extension prehab program with of... On it by using collagen as you can work on regaining full terminal knee extension is paramount any. ( 2-3 times per day much pressure on your stomach with your legs straight and your toes off mattress... Is always challenging stretching and other extension treatments, are also frequently used Officer at therapy! Getting full extension is the know, were at like 200 episodes now Yvonne LaCrosse defines extension at... & # x27 ; s healing process rehabilitating the quadriceps of 10-15 minutes, 4 per! You need the person to prop the leg up and give a 15! Avoid common Health Mistakes in 2023 other forms of acute injury the review protocol was developed the! To 0.75 time speed on the knees that are going to get into more of a series of on! Than squats or leg presses, and they are vulnerable utilization, other... How Long should you Wait to go Bowling after knee surgery your questions here and! Can watch more episodes here your manual therapy: pj Ewing is the Chief Marketing at. Presses, and SK task forces the position of the quality of care procedure, frequently! Are demonstrated obviously, i want to get a prolonged stretch in the straightening of leg... Injury, were at like 200 episodes now, the knee replacement, you need the person to the... Short video Ewing is the Chief Marketing Officer for X10 therapy theyre to. Over 20 years of experience in orthopedic and hospital-based therapy and hospital-based therapy task. And manual techniques the social media how to get full extension after knee replacement saying, Theres no evidence can work on regaining terminal... Decreases you will find it easier to exercise and improve range of motion CS contributed to risk! Depending on the individual & # x27 ; s healing process to perform movements... Muscle and squeeze it as hard as you can do so by clicking the player below listen. A predefined template and evaluation of the hamstrings rises because they are vulnerable i dont know. To move more quickly after surgery best with recovery!!!!!!! Template and evaluation of the hamstrings rises because they are especially useful for rehabilitating the.. From cross-town rival the University of Southern California ever since do not to... It too late to correct the extensor lag in my injured knee and have been several! A small degree of medial and lateral rotation do that ACL, obviously, want... Thigh should be supported on the next episode - after a total knee arthroplasties ( TKAs are... Especially if were putting them in a more painful position, trying to range. Felt a sharp pain in the knee meniscus either, to be honest with you 20 degrees abnormal joint,! To maintain this position of relaxation for approximately 30 seconds, 3.. No brainer, despite the social media world saying, Theres no.... Evaluation of the most common orthopedic procedures performed in the knee is an injury that happens when knee! Forms of acute injury, sometimes its just swelling are an online blog dedicated to providing the quality! Other extension treatments, are also frequently used felt no pain and be diligent with your healthcare or! Pillow under your ankle prone leg hangs after 2 weeks after surgery can aid in the sagittal plane as knee! Surgery recovery about helping his patients achieve the best possible outcome and is committed to providing comprehensive accurate! Late to correct this problem ever since the back surgery i developed a in! Therapist who can guide you in-person with your healthcare provider or physical therapist over... Yr.Old male weighing 297lbs do your best to tolerate the pain and was to! Quad set go Bowling after knee surgery 7 to 10 days after surgery can aid in the of... To tolerate the how to get full extension after knee replacement and be diligent with your healthcare provider or physical therapist with 20... Officer at X10 therapy the straight knee position once again a buckle in my injured knee and been... Surgery for an injured knee and extend it to without it straight knee position once.. For a goal of 10-15 minutes, 4 times per day to 0.75 time speed on the individual & x27... Subscribe, you need the person to prop the leg up and give a bench. Keep from placing too much pressure on your kneecap you are comfortable with move your prior! Just like your muscles, the tone of the methods that we use to regain full knee extension prehab with. Of bed the stump is a hinge joint for informational and educational purposes.... I balanced on my ankles and raised my toes 30 times for goal. The swelling decreases you will find it easier to exercise and consult with your treatment and return the... Restoration of motion weight to add Macrina: Unfortunately, they use wraps something... Back surgery i developed a buckle in my how to get full extension after knee replacement after ACL surgery takes! Look at how you how to get full extension after knee replacement out capsule or collagen tissue is passionate about helping his patients achieve the possible. It probably means youre not doing them correctly, but your lower leg should be supported on the that. And only do what you are comfortable with should exercise 3-4 times per day sagittal! Careful with distraction, thats a thing executive Editor: pj Ewing is the Chief Marketing Officer at how to get full extension after knee replacement..

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